In Cambodia, we are often not so fortunate. Here, we must rely more so on history and physical exam findings. Here, we may have no specialists to refer patients. Here, we may treat based on a suspected diagnosis and reassess based on clinical response.

On a particular day in clinic, we treated a middle aged female for likely tension headaches, osteoarthritis, and GERD, all too common complaints here, for which she was very grateful as are all the humble patients in this country. However, an astute undergraduate student working with the team at the time questioned me regarding what appeared to be a small midline neck mass. Upon further palpation and exam, it appeared to be a goiter or enlarged thyroid gland. The patient upon prompting then reported recent weight gain, worsening fatigue, and cold intolerance, consistent with probable hypothyroidism. Even without the ability to test for TSH/T4 levels, the findings in the history were consistent with those noted on physical exam, and a more complete clinical picture was painted. I was reminded of the value of a complete physical exam - a practice that is sometimes forgotten in the United States where we have an assortment of tests and imaging at our disposal. However, the physical exam is important for another reason - the human connection. Laying hands on a patient confers a certain connection between patient and caregiver and demonstrates our dedication to their well-being. It shows we care. It shows we are in this together. And a simple touch can go a long way in a country like this. We ultimately referred this patient to a local hospital for further work-up but it all began with a simple physical exam finding which has the potential to make a huge difference in the patient's day to day life, giving her back some of the energy that she has lost.